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National TB Programme
Managers of the Region adopt new target for TB control
 The
Meeting of the National TB Programme Managers of the Region, together with
representatives from several technical and development partner
organizations, and WHO collaborating centres in the Region, held at the WHO
Regional Office for South-East Asia,
concluded on 5 November 2009. Following an in-depth review of progress,
challenges and gaps in implementing the Stop TB strategy in Region as a
whole and in country specific contexts, participants concluded that while
much progress had indeed been achieved, innovative approaches and adoption
of more recent guidelines for interventions were called for to make further
significant progress in TB control. Current national TB control plans were
therefore critically reviewed in the light of recent guidelines and
developments in area of TB control. The discussions resulted in consensus
on adopting the new WHO target of universal case detection as opposed to
the present target of 70%, and on the possible means to reach this target.
Discussions were also held on the application of newer diagnostics,
adoption of the revised treatment guidelines, and acceleration of
interventions to address particularly multi-drug resistant-TB, HIV
associated TB, infection control and childhood TB.
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 International
Trainings and Workshops on TB
Operational Research Course
 Course brief
[PDF 69 KB]
Application
form [PDF 65 KB]
National AIDS and TB
Managers of the SEA Region focus on accelerating interventions to address
HIV associated TB.
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The TB Unit of the WHO Regional Office for South-East
Asia assists countries in the Region in achieving set targets for TB control through policy guidance, advocacy, planning, information exchange, technical support, assistance for human resource development, resource mobilization, monitoring and evaluation and operational
research. Under the Regional Strategic Plan 2006–2015, intensified action
to add impetus to current efforts and promote additional interventions for
TB control is envisaged.
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Highlights
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Good progress in TB
Control in the SEA Region
 Countries
in the South East Asia Region have continued to make steady progress with
TB control during the past year. During the year 2007, more than 2 million
TB patients were initiated on treatment in the Region. Based on data from
the annual reports from National TB programmes in Member countries in 2008,
six countries in the Region have now achieved both the 70% case detection
and 85% treatment success rates. As a result, the overall case detection
rate in the Region is now 69%. The treatment success rate for the cohort of
new smear positive TB patient initiated on treatment during 2006 was 87.5%.
Major achievements during the year were the establishment and scaling up of
interventions for TB/HIV, multidrug-resistant TB and further expansion of
private and public partnerships for the provision of TB care in Member
countries.
More…
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NEWS UPDATES
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TB/HIV in Asia and Pacific:
Progress Report
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 Catalyzing the implementation of collaborative HIV/TB activities
in the Asia and Pacific regions is a key
priority. This region has more than
half of the global burden of TB and 12% of the global burden of HIV. The
mortality among people dually affected with HIV and TB in the Asia- Pacific
remains high at over 50%. In the context of more effectively addressing the
morbidity and mortality of this dual burden in this Region, a meeting
entitled "From Mekong to Bali: scale up of HIV/TB collaborative
activities in Asia Pacific" was organized by WHO HQ, SEARO and WPRO in
collaboration with the HIV/TB Working Group of the Stop TB Partnership,
between 8-9 August 2009, in Bali, Indonesia. National TB and HIV program
managers from 18 countries were joined by a broad range of AIDS and TB
stakeholders, members of the HIV/TB Working Group and representatives of
bilateral and multilateral organizations, NGOS, and faith based
organizations. Participants shared experiences and best practices and
developed plans to accelerate the implementation of nation-wide
collaborative HIV/TB activities. The meeting followed on from the first
regional HIV/TB meeting held in the Mekong sub region in Ho Chi Minh City, Vietnam
in October 2004.
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| Sir John
Crofton passes away
[PDF 49 KB]
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 Sir John was an eminent physician and was best
known for his pioneering work in TB chemotherapy and his contributions to
Tuberculosis Control around the world including in this Region. He was at
the forefront of combating TB until the very end. He was also a leading
international figure in tobacco control. In 1984, he became the first
chairman of the tobacco and health committee of the International Union
Against Tuberculosis and Lung Disease. His work to stem widespread use of
tobacco continued well into his later years, with a ban on cigarette
advertising remaining one of his major concerns. He worked for many years
with the World Health Organization both on TB as well as on tobacco
control. Sir John, who lived in Edinburgh,
passed away peacefully on November 3 2009, aged 97.
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World Leaders and
Experts discuss Multidrug and Extensively drug resistant TB
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1-3 April 2009
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 Representatives from the countries with the highest burdens of
TB and MDR-TB, development partners, affected communities and technical
agencies were invited to a ministerial meeting entitled "Global
Tuberculosis control and Patient care: A Ministerial meeting of high
multidrug and extensively drug resistant-TB (MDR/XDR-TB) burden countries,
in Beijing, China, between 1-3 April 2009. The meeting organized by WHO
with support from the Gates Foundation and hosted by the Ministry of Health
of China, was organized primarily to stimulate higher level political actions
within the broader context of health systems, recognizing that M/XDR-TB
cannot be overcome through the efforts of National TB Control Programmes
alone.
One of
the key outcomes of the meeting was a “Call for Action on Tuberculosis
Control and Patient Care” which recognises M/XDR-TB as a threat to global
public health security with the potential to severely undermine current
progress in global TB control and the achieving of the TB-related targets
under the Millennium Development Goals. The meeting also resulted in
outlining the key actions that needed to be undertaken by Member countries,
technical agencies and development partners engaged in TB care and control,
in order to achieve universal access to diagnosis and management for all
M/XDR-TB patients by 2015. The call for action and other outcomes of the
meeting will form the basis of a resolution on the prevention and control
of M/XDR-TB to be presented by China at the forthcoming World
Health Assembly in May 2009. More…
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UV LIGHTS SHOWN TO CUT
SPREAD OF TB
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16
March 2009
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Ultraviolet
lights could reduce the spread of tuberculosis in hospital wards and
waiting rooms by 70%, according to a new study, published in PLoS Medicine
today. The study, which explored the transmission of tuberculosis (TB) from
infected patients to guinea pigs, suggests that installing simple
ultraviolet C (UVC) lights in hospitals could help reduce the transmission
of TB, including drug-resistant strains.
Infection
rates are particularly high in places where vulnerable people are crowded
together, such as hospitals, homeless shelters and prisons. When a
tuberculosis patient coughs, bacteria are sprayed into the air in tiny
droplets, floating around the room and infecting other patients, visitors
and healthcare staff. These bacteria can be killed by hanging a shielded
UVC light from the ceiling with a fan to mix the air, say the researchers,
from Imperial College London, University of Leeds, Hospital Nacional Dos de
Mayo, Lima, Perú and other international institutions. Introducing UVC
lights could be a relatively low-cost measure, with a typical UVC ceiling
light costing around US$350 and replacement bulbs around US$25. Researchers
are now working to develop more affordable US$100 units. Plans are already
underway to install upper room UV lights in the chest clinic at St Mary's
Hospital, part of the Imperial College Healthcare NHS Trust, which will be
the first hospital to have them in the UK.
Source: PLoS Medicine, March 16 2009
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CDC Issues Plan to
Combat Extensively Drug-resistant TB
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13
Feb 2009
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The Federal Tuberculosis Task Force convened by the CDC
has issued a plan to combat extensively drug-resistant TB (XDR- TB),
according to a report published in the February 13 issue of the Morbidity
and Mortality Weekly Report. While calling for more funding and renewed
commitment by government and other organizations, the Task Force made
recommendations for specific actions within 9 response areas to facilitate
XDR-TB prevention and control.
These 9 areas are diagnostic laboratory; surveillance,
epidemiology, and outbreak investigation; infection control; clinical and
programmatic interventions; ethical and legal issues; communication and
education; research; partnerships; and cost-analysis, which mirror the
World Health Organization's 7-point Global Action Plan to Combat XDR TB.
The Task Force concluded that "TB represents a substantial public
health problem in low- and middle-income countries, many of which might
benefit from assistance by the United States. The Task Force
will coordinate activities of various federal agencies and partner with
state and local health departments, nonprofit and TB advocacy organizations
in implementing the plan to control and prevent XDR TB in the United States
and to contribute to global efforts in the fight against this emerging
public health crisis.”
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Extracted from the Morb Mortal Wkly Rep. 2009; 58 (RR03);1–43
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TB and HIV treatment
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Study halted due to
inferior results in patients taking Nevirapine and Rifampicin
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11 Feb 2009
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Tuberculosis (TB) is the single biggest cause of serious
illness and death for people with HIV around the world. While it is
possible to cure TB in people with HIV, antiretroviral treatment needs to
be used with care in people taking TB treatment. The reasons are two
fold--some anti-retrovirals interact with anti-TB drugs, and the risk
of developing the immune reconstitution inflammatory syndrome (IRIS).
Antiretroviral therapy particularly in resource-limited
settings is normally based on the NNRTIs efavirenz or nevirapine.
Nevirapine is generally preferred because it is cheaper, has been
well-studied in pregnant women and children, and comes in a variety of
fixed-dose combinations.
But researchers at the Tuberculosis Research Centre, Chennai, India, have found that only 67%
of patients taking nevirapine-based HIV treatment and rifampicin-based TB
therapy had a viral load below 400 copies/ml after six months of treatment
compared to 85% of those who took efavirenz-based HIV treatment and TB
therapy together.
The researchers halted the study because of these
results.
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HIV treatment for
children taking Rifampicin-based TB therapy
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11 Feb 2009
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Even if the dose of the protease inhibitor
lopinavir/ritonavir (Kaletra) is doubled for young children taking
rifampicin-based TB treatment, levels of Kaletra are still too low to
effectively treat HIV, research shows.
In a study conducted in South Africa, children were
given the liquid formulation of Kaletra. The median age of the children was
15 to 19 months. Results showed that even when the dose of Kaletra was
doubled, its levels were reduced by between 82% and 51% in infants also
taking rifampicin-based TB treatment. The researchers therefore concluded
that this treatment approach “should not be recommended in young children
and that there was an urgent need to establish safe, effective and feasible
co-treatment for young children with HIV-associated TB”.
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Extracted from
Daily news updates: 16th Conference on Retroviruses and Opportunistic
Infections, 8-11 February 2009, Montreal,
Canada
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15 Dec 2008
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Partners Meeting on TB
drug Procurement in Myanmar
 A Partners Meeting on
Sustainable TB Drug Supply in Myanmar was convened by
Ministry of Health on 1 December 2008, in Nay Pyi Taw. The meeting, chaired
by HE. Prof. Dr. Kyaw Myint, Minister of Health, was organized to seek
assistance to fill a critical funding gap for first-line anti-TB drugs in
the country. Following the completion of an exceptional seventh year of free
grants of first-line anti-TB drugs through the Global Drug Facility, the
National TB Programme in Myanmar will face an acute shortage of drugs to
treat the over 150,000 cases of TB being registered by the programme every
year from 2010 onwards. The programme estimates that an additional USD 4
million will be needed every year, in addition to the funding being
provided through the national health budget, for these drugs. The meeting
ended with optimistic perspectives on the possibilities to bridge the gap
by several partners, based on their on-going or future expected support to
the country.
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19 Nov 2008
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Addressing HIV and IDU
issues vital for TB programmes
More than 90% of the diagnosed TB patients are
successfully completing treatment in Nepal today. Nepal's anti-TB
programme has received appreciation in the South-East Asian region as a
result of ongoing government commitment, community support, forging wide
range of partnerships, and the use of innovative ways of ensuring access to
DOTS - especially in remote areas, said Dr Dirgh Singh Bam, Secretary,
Ministry of Health, Nepal, who is also the former Vice-President of Nepal's
Anti-Tuberculosis Association (NATA).
Nepal
reports up to 29% TB-HIV co-infection. Dr Bam talking about TB and HIV
co-infection, mentioned that it was a
particular problem among the injecting drug users (IDUs) in Nepal.
“It is difficult to reach out to the IDU community to deliver healthcare
services and the need to work in partnerships is critical”, he said.
"Without addressing HIV and IDU issues, it will be very difficult to
effectively respond to TB". People who use injecting drugs, and
co-infected with HIV/TB, are also at increased risk of Hepatitis C (HCV) in
Nepal.
"Community participation is very essential for
effective TB/HIV care in Nepal"
emphasized Dr Bam. Patients who have successfully completed TB treatment
were leading district level TB committees to improve TB programme
performance in many instances in Nepal.
The Patients' Charter for Tuberculosis Care, outlines
the rights and responsibilities of people with tuberculosis. It empowers
people with the disease and their communities through this knowledge. Dr
Bam urged that the Patients' Charter for Tuberculosis Care be used as a
tool to empower people with TB to become aware of their rights and
responsibilities, to further improve the performance of TB programmes.
Excerpt from an
article in the AMERICAN CHRONICLE : November 19, 2008 by Bobby Ramakant
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Interpol Seizes Fake Drugs in Asia
The global police force Interpol in through a
multi-country “Operation Storm” seized fake drugs worth an estimated 6.6
million US dollars, intended to treat tuberculosis, HIV/AIDS and
antibiotics for pneumonia and childhood illnesses.More than 16 million
counterfeit pills were confiscated through police raids between mid-April
and September 15 in seven countries, Cambodia, China, Laos, Myanmar,
Singapore, Thailand and Vietnam. The police action was supported by the
World Health Organisation and the World Customs Organisation.
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8
October 2008
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Focus on MDR-TB in Asia
The Lancet in an article entitled “Asia takes
action on drug-resistant tuberculosis” focused on the response to
multi-drug resistant TB (MDR-TB) in Asia,
saying that the region could yet prove the decisive battleground in the
international war on the disease. More than 300 000 TB cases are estimated
to have multi-drug resistance in the Asia
–Pacific. However, only 1% of these patients currently receive treatment.
Seven countries in the SEAR Region have established are gradually expanding
MDR-TB treatment programmes under the national programmes. At the same
time, the emphasis is on using the window of opportunity provided by yet
low multi-drug resistance rates, to put in cost-effective interventions to prevent the further emergence of MDR-TB. How
current efforts to control MDR tuberculosis in Asia will affect the longer-term global spread of the disease remains to be seen.
Full article: www.thelancet.com/infection Volume 8 October 2008
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Unified Strategy Needed to Beat Big Killers
THE GUARDIAN (UK)
In an article analyzing global progress towards Goal 6
of the Millennium Development Goals, the Guardian reported that while
significant strides had been made in tackling three of the world's
deadliest diseases - HIV/Aids, TB and malaria, with signs that numbers of
new infections were levelling off, TB-HIV co-infection could pose a threat
to further progress In 2006, of the 9.2 million new cases of TB and the 1.7
million deaths caused by the disease, 700,000 cases and 200,000 deaths were
in HIV-positive people. Similarly there is also growing awareness of the
interaction of malaria and HIV, with infection with one disease increasing
the susceptibility to infection with the other. The growing coordination
against the three diseases at international level is encouraging. At the
International Aids conference in Mexico in August, Roll Back
Malaria backed a campaign for the free distribution of insecticide-treated
bed nets to people living with HIV and Aids. In June this year, the first
HIV/TB global leaders forum was organized at the UN headquarters. The Stop
TB Partnership's Global Drug Facility, Unitaid, an international facility for
purchasing drugs to combat HIV, malaria and TB, the WHO and the Foundation
for Innovative New Diagnostics pledged to accelerate efforts to control
drug-resistant TB with funding for new treatment in 54 countries and new
labs in up to 16 countries. More…
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04 August 2008
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Targeted action on HIV and tuberculosis needed to reach drug users
Addressing TB/HIV is a key theme of the 2008
International AIDS Society conference being held in Mexico
City and comes two months after world leaders issued a call to
drastically cut the number of TB/HIV deaths by 2015 at the landmark Global
Leaders' Forum on the co-epidemic, held at the UN headquarters in New York. More…
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02 July 2008
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Stop TB Partnership's Global Drug Facility, UNITAID, WHO and FIND
launch initiative to accelerate MDR-TB control
People in low-resource countries who are ill with
multidrug-resistant TB (MDR-TB) will get a faster diagnosis -- in two days,
not the standard two to three months -- and appropriate treatment thanks to
two new initiatives unveiled today by the Stop TB Partnership, the World
Health Organization (WHO), UNITAID and the Foundation for Innovative New
Diagnostics (FIND).
At present it is estimated that only 2% of MDR-TB
cases worldwide are being diagnosed and treated appropriately, mainly
because of inadequate laboratory services. The initiatives announced today
should increase that proportion at least seven-fold over the next four
years, to 15% or more.
"I am delighted that this initiative will
improve both the technology needed to diagnose TB quickly, and increase the
availability of drugs to treat highly resistant TB," said British
Prime Minister Gordon Brown, who helped launch the Stop TB Partnership's
Global Plan to Stop TB in 2006 and whose government is a founding member of
UNITAID. "The UK
is committed to stopping TB around the world, from our funding of TB
prevention programmes in poor countries, to our support of cutting edge
research to develop new drugs."
The new initiative consists of two projects. The
first, made possible through US$ 26.1 million in funding from UNITAID, will
introduce a molecular method to diagnose MDR-TB. These rapid, new molecular
tests, known as line probe assays, produce an answer in less than two days.
WHO's Global Laboratory Initiative and FIND will help countries prepare for
installation and use of the new tests.
Under a second, complementary agreement with
UNITAID for US$ 33.7 million, GDF will boost the supply of drugs needed to
treat MDR-TB in 54 countries, including those receiving the new diagnostic
tests. In the South-East Asia Region, Myanmar,
Nepal
and Timor- Leste already benefit through this mechanism.
Speaking at a press conference today, GDF General
Manager Robert Matiru congratulated the partners on this groundbreaking
collaboration, noting they are "laying the foundation for a global
response to accelerating access to treatment and care for patients with
drug-resistant TB." Press release
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09 June 2008
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Global Leaders Gather at UN Forum to Tackle Tuberculosis Threat
On
the eve of a high-level meeting on AIDS, being attended by government
leaders, health and business officials, heads of United Nations agencies
and activists, Dr. Jorge Sampaio the Secretary-General’s Special Envoy to
Stop TB, convened a meeting to confront tuberculosis, the leading cause of
death for people living with HIV.
This
first HIV/TB Global Leaders’ Forum which brings together several
stakeholders and partners is being attended by Dr. Peter Piot, Executive
Director of the Joint UN Programme on HIV/AIDS (UNAIDS), and Dr. Margaret
Chan, Director General of the World Health Organization (WHO, to discuss
the impact of the TB and HIV epidemics.
TB
accounts for an estimated quarter of a million deaths each year among those
living with HIV and is the number one cause of death among people living
with HIV in Africa. Recently, WHO, UNAIDS
and the UN Children’s Fund announced that some three million people are now
receiving life-saving anti-retroviral treatment. However, TB, especially
drug-resistant forms of the disease, threatens to hinder this progress.
HIV
and TB are so closely connected that they are often referred to as
co-epidemics or dual epidemics that drive and reinforce one another. Since
HIV weakens the immune system, people living with the virus are up to 50
times more likely to develop TB than those who are HIV negative. Without
proper treatment with anti-TB drugs, the majority of people living with HIV
die within two to three months of becoming sick with TB.
The
Forum, which is co-sponsored by the Global Fund to Fight AIDS, Tuberculosis
and Malaria and the Stop TB Partnership, is expected to produce a Call for
Action to drastically cut the number of deaths associated with HIV/TB. Source: UN News Centre at http://www.un.org/news
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